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Implementation of A Real-time Compliance Dashboard to Help Reduce Ventilator-Associated Pneumonia with Ventilator Bundle

Objective To investigate the effect of a real-time compliance dashboard to help reduce ventilator-associated pneumonia ( VAP) with ventilator bundle. Methods 240 patients who were admitted into the intensive care unit ( ICU) of Shougang Hospital of Peking University and had received mechanical ventilation ( MV) for over 48 hours, between January 2010 and November 2011, were studied prospectively. The patients were divided into two groups by random number table, ie. a dashboard group ( n = 120) with implementation of a real-time compliance dashboard to help reduce VAP with ventilator bundle, and a control group ( n=120) with implementation of usually routine order to help reduce VAP with ventilator bundle. The success rate of ventilator bundle implementation, incidence of VAP, duration of MV, duration within ICU, mortality within 28 days, cost within ICU were compared between two groups. Results Compared with the control group, the success rate of ventilator bundle implementation obviously increased ( 81.6% vs. 52.5%) , incidence of VAP ( 14. 5/1000 days of MV vs. 36.2 /1000 days of MV) , duration of MV [ 5( 4,7) days vs. 8( 6,11) days] , duration within ICU [ 8( 6,12) days vs. 13( 8,16) days] , mortality of 28 days ( 12.6% vs. 28.6% ) , and cost within ICU ( 36,437 vs. 58,942) in the dashboard group obviously reduced ( Plt;0.05) . Conclusions Implementation of a real time compliance dashboard to help reduce VAP with ventilator bundle can obviously improve medical personnel compliance and reduce incidence of VAP, duration of MV, duration within ICU, mortality and cost in ICU than those of routine medical order to help reduce VAP with ventilator bundle.

Clinical Analysis of 34 Patients with Severe H1N1 Influenza

Objective To analyze the clinical features and treatment of severe H1N1 influenza.Methods The clinical data of 34 patients with severe H1N1 influenza admitted to intensive care unit from October to December 2009 were reviewed. Results The patients aged 3 months to 60 years with an average of ( 13. 9 ±4. 5) years, of which 24 patients were younger than 7 years old. Fever( 30 cases) , cough( 32 cases) , progressive shortness of breath( 19 cases) were the main symptoms. White blood cell count was normal in 21 cases, increased in 6 cases, and decreased in 7 cases. Lymphocyte count was normal in 16 cases, increased in 12 cases, and decreased in6 cases. Chest X-ray films showed bilateral or unilateral patchy pulmonary fuzzy shadows in28 cases. Chest CT showed diffuse interstitial lesion in1 case, pleural effusion in 2 cases, and bronchiectasis in 1 case. The hepatic and myocardial enzymogramparameters were all abnormal.30 cases were treated by oseltamivir and ribavirin, 4 cases by methyllprednisolone, and 6 cases by gamma globulin. 8 cases underwent routine intubation and mechanical ventilation, and 5 cases received non-invasive mechanical ventilation. All 34 patients were cured. Conclusions Lung, heart, and liver are the major target organs in severe H1N1 influenza. Mechanical ventilatory support is an important treatment for severe H1N1influenza.

经皮微创气管切开时机对危重病患者预后影响的比较

目的 研究经皮气管切开时机与危重病患者预后的关系。方法 按照平行对照设计原理, 将70 例入住重症加强治疗病房( ICU) 需要行机械通气的患者按经皮气管切开时间早晚分为早期组( 机械通气后3 d 内行气管切开) 和晚期组( 机械通气10 d 后行气管切开) 。对两组患者入院 28 d脱机时间、成功脱机率、ICU转出率、呼吸机相关性肺炎( VAP) 发生率进行比较。结果 与早期组患者比较, 晚期组患者28 d 脱机时间显著减少[ ( 6. 13 ±0. 92) d 比( 10. 64 ±1. 47) d] , 成功脱机率显著下降( 54. 3% 比71. 4% ) , ICU转出率显著下降( 48. 6% 比65. 7% ) , VAP发生率显著增加[ 48. 6% 比28. 6% ] ( P 均lt;0. 05) 。结论 早期经皮气管切开可以增加入院28 d 脱机时间、成功脱机率和 ICU转出率, 降低VAP发生率, 改善危重病患者的预后。

机械通气患者鼻饲返流误吸的护理干预

目的:减少机械通气患者鼻饲时的误吸,为患者更好的提供营养支持,促进患者早日康复。方法:通过改进胃管长度、抬高床头、匀速泵入营养液、增加胃动力药物、掌握好吸痰时机等方法。结果:80 例患者中15 例发生返流,经改进方法后,患者愈后好。结论:通过上述方法对机械通气患者鼻饲返流误吸的发生可有效的防止。

Application of BiLevel Positive Airway Pressure Mechanical Ventilation on Cardiac Surgery Patients in Intensive Care Unit

【摘要】 目的 探讨双水平无创正压通气(BiPAP)对心脏外科术后需要二次机械辅助通气患者的治疗效果。方法 2008年9月—2009年9月，收集心脏外科手术后成功脱离呼吸机辅助通气后心功能衰竭或呼吸功能衰竭需要二次机械通气的患者,符合纳入及排除标准者共53例，进行回顾性分析,根据治疗方案分为无创通气组(32例)和有创通气组(21例),在需要机械通气时(T1),机械通气后30 min(T2),机械通气后2 h(T3)及预计脱离机械通气时(T4),分别统计患者心率、血气分析等情况,比较氧分压、ICU停留时间及术后至出院时间。结果 给予辅助通气前,两组患者的心率及PO2无统计学差异(Pgt;0.05)。给予辅助通气后,无创通气组患者的心率由T1(130.8±21.10)次/min,下降到T2(125.60±21.36)次/min,T3(101.70±13.73)次/min,T4(87.40±9.35)次/min；PO2由T1(64.70±14.12) mm Hg,上升到T2 (121.40±30.19) mm Hg，T3 (140.40±25.29) mm Hg，T4 (132.90±16.33) mm Hg。有创通气组患者的心率由T1 (138.27±21. 39)次/min,下降到T2(118.18±18.03)次/min，T3(100.00±11.73)次/min，T4(87.00±10.70)次/min；PO2由T1 (61.45±13.56) mm Hg上升到T2(122.55±29.50) mm Hg，T3(138.91±24.77) mm Hg，T4(133.55±18.00) mm Hg。两组患者心率及PO2均较辅助通气前降低(Plt;0.05)。两组患者之间各时间点心率及PO2比较无差异(Pgt;0.05)。无创通气组的ICU停留时间及术后至出院时间分别为(1.75±2.97) d及(9.14±4.11) d，均低于有创通气组的(4.38±5.13) d及(14.00±0.82) d,有统计学意义(Plt;005)。结论 双水平无创正压通气可用于心脏外科术后需要二次机械通气的患者。

A comparative study of effectiveness of biphasic positive airway pressure，VV+，assist-control ventilation and pressure support ventilation on acute respiratory failure of chronic obstructive pulmonary disease

Objective To investigate the therapeutic effects of biphasic positive airway pressure (Bilevel) ventilation and volume ventilation plus [VV+，including volume control plus (VC+) and volume support (VS)] on respiratory failure in patients with chronic obstructive pulmonary disease (COPD).Methods 63 patients with COPD complicated by acute respiratory failure were intubated and underwent mechanical ventilation for at least 24 hours.At the first patients were underwent assist-control (A/C) ventilation for 2 to 4 hours to obtain the suitable basic ventilatory parameters.Meanwhile，the hemodynamics and oxygen dynamic parameters were measured.Then the patients were randomly allocated to three groups with 21 patients in each group and the ventilation mode was switched to Bilevel，VC+ and A/C mode correspondingly.The setting parameter was identical in three modes.In the process of weaning，patients in Bilevel group were ventilated with Bilevel and pressure support ventilation (PSV) mode at each pressure level，and subdivided into Bilevel and PSV 1 group accordingly.In VC+ group，the mode was switched to VS and PSV mode and subdivided into VC+ group and PSV 2 group,respectively.Every mode was run for 30 minutes while the ventilation function，blood gas exchange and lung mechanics index were measured.Results In the initial stage，the airway peak pressure (PIP) of Bilevel and VC+ mode obviously decreased，and the respiratory compliance was higher compared to the A/C mode. The effectiveness of Bilevel and A/C was equivalent in improving alveolar ventilation and oxygenation.The difference in the change of circulation function and blood gas between the two groups were not significant (Pgt;0.05).In the process of weaning，the effectiveness of Bilevel and VV+ was equal to PSV.The changes of breathing mode and blood gas between the two groups had no significant differences.Conclusions Bilevel and VV+ mode ventilation can be used in the whole mechanical ventilation for acute respiratory failure due to COPD with lower PIP，higher respiratory compliance compared to A/C model and similar performance as PSV during mechanical ventilation withdrawn.

无创通气辅助困难撤机气管切开患者成功撤机一例

Clinical Analysis on Neonatal Respiratory Failure

ObjectiveTo explore the incidence, treatment and prognosis of neonatal respiratory failure (NRF). MethodsThe clinical data of 421 neonates with NRF treated between January 2011 and December 2013 were retrospectively analyzed. ResultsThe incidence and the mortality of NRF was 4.8% and 14.5%, respectively. The main primary disease of NRF was neonatal respiratory distress syndrome (36.1%) and aspiration pneumonia (29.0%). Mechanical ventilation was the main treatment for NRF (77.2%). Premature (χ2=12.216, P<0.001), low birth weight (χ2=8.932, P=0.003) and the neonatal asphyxia (χ2=6.199, P=0.013) were closely related to the prognosis of NRF, which were the risk factors of the death of NRF. ConclusionNRF is a disease with high incidence and high mortality; make effective prevention and treatment measures are important to improve the success rate of therapy for NRF.

Humidification Effect of MR410 Humidification System and MR850 Humidification System on Patients with Invasive Mechanical Ventilation:A Comparative Study

Objective To compare the humidification effect of the MR410 humidification system and MR850 humidification system in the process of mechanical ventilation. Methods Sixty-nine patients underwent mechanical ventilation were recruited and randomly assigned to a MR850 group and a MR410 group. The temperature and relative humidity at sites where tracheal intubation or incision, the absolute humidity, the sticky degree of sputum in initial three days after admission were measured. Meanwhile the number of ventilator alarms related to sputum clogging and pipeline water, incidence of ventilator associated pneumonia, duration of mechanical ventilation, and mortality were recorded. Results In the MR850 group,the temperature of inhaled gas was ( 36. 97 ±1. 57) ℃, relative humidity was ( 98. 35 ±1. 32) % , absolute humidity was ( 43. 66 ±1. 15) mg H2O/L, which were more closer to the optimal inhaled gas for human body.The MR850 humidification system was superior to the MR410 humidification system with thinner airway secretions, less pipeline water, fewer ventilator alarms, and shorter duration of mechanical ventilation. There was no significant difference in mortality between two groups. Conclusions Compared with MR410 humidification system, MR850 humidification system is more able to provide better artificial airway humidification and better clinical effect.

有创-无创序贯性机械通气在肺挫伤致急性呼吸窘迫综合征中的应用价值

目的 观察有创-无创序贯机械通气在肺挫伤致急性呼吸窘迫综合征( ARDS) 中的应用价值。方法 选择肺挫伤致ARDS 患者44 例, 随机分为序贯治疗组和对照组, 每组22 例。所有病例均气管插管行机械通气, 通气模式为同步间歇指令通气( SIMV) + 压力支持通气( PSV) + 呼气末正压( PEEP) 。当ARDS 控制窗出现时, 序贯治疗组依次选择双水平正压通气( BiPAP) 至停机通气模式, 对照组选择SIMV + PSV + PEEP 至停机通气模式。结果 序贯治疗组有创通气时间[ ( 4.5 ±2.5) d 比( 13.1 ±4.9) d] 、总机械通气时间[ ( 14±2) d 比( 19±1) d] 、呼吸机相关性肺炎( VAP) 发生率 ( 9.1%比40.9% ) 、ICU住院时间[ ( 17±3) d 比( 22±4) d] 、病死率( 13.6% 比31.8% ) 与对照组比较差异均有统计学意义( Plt;0.05) 。结论 有创-无创序贯机械通气是治疗肺挫伤致ARDS 的安全、有效的方法, 能明显缩短有创通气时间和总机械通气时间, 降低VAP发生率, 缩短ICU住院时间, 降低病死率。